November 29, 2011 | | Comments 3
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PT/OT, oh where did you go?

For those who work in environments where codes from category V57 (care involving use of rehabilitation procedures) are a staple, you be surprised to learn that when it comes to ICD-10-CM, all V57 codes map to the same ICD-10-CM code (Z51.89). In ICD-9-CM, the codes within category V57 help to identify a variety of therapies that providers administer to patients:

  • V57.0 (breathing exercises)
  • V57.1 (other physical therapy [except breathing exercises])
  • V57.2x (encounters for occupational or vocational therapy)
  • V57.3 (speech-language therapy)
  • V57.4 (orthoptic training)
  • V57.8x (orthotic and other training or therapy)
  • V57.9 (unspecified rehabilitation procedure)

An instructional note corresponding to category V57 codes states that coders should assign an additional code for the underlying condition or reason for such rehab procedures (e.g., late effect of cerebrovascular accident with aphasia, hemiplegia, or aftercare of a fracture).

When referencing the ICD-9-CM to ICD-10-CM general equivalency mappings (affectionately called “GEMs”), all of these codes (that by the way have some specificity in ICD-9-CM) map only to one ICD-10-CM code Z51.89 (encounter for other specified aftercare). There is an instructional note in ICD-10-CM that states to “code also condition requiring care,” but does this diagnosis really identify whether the therapy provided was physical therapy, occupational therapy, or vocational therapy? Not so much.

This concept is important because the American Hospital Association’s (AHA) Coding Clinic, Third Quarter, 2006, instructed inpatient rehab hospitals to use a V57 code as the principal diagnosis. We know that the AHA is not going to translate the ICD-9-CM Coding Clinics to ICD-10-CM, but for the sake of rehab hospitals I do hope that some guidance is provided sooner than later if they are not to assign the encounter for rehab code as the principal diagnosis. Maybe the thought is that ICD-10-CM code Z51.89 identifies with as much detail as is necessary for reporting for inpatient rehab? If we still are to assign additional codes for the conditions requiring care then it should be ok, right?

Clearly we found a reason to have specific codes in ICD-9-CM, so maybe we ought to stay tuned for more specificity to filter over into the ICD-10-CM codes for inpatient admissions for rehab.

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Shannon McCall About the Author: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, is director of coding and HIM at HCPro, Inc. Shannon serves as the director over the Certified Coder Boot Camp ® programs. She developed the Certified Coder Boot Camp® – Inpatient Version, the Evaluation and Management Boot Camp and most recently the ICD-10 Basics Boot Camp®. As a member of HCPro, Inc.’s Revenue Cycle Institute, Shannon works with hospitals, medical practices and other healthcare providers on a wide range of coding-related issues with a particular focus on education. Shannon has extensive experience with coding for both physician and hospital services. Prior to joining HCPro, she worked for a national medical practice management company, where her duties included serving as a client manager and as an instructor for the in-house coding training. Shannon also previously worked for a national consulting firm focusing on hospital inpatient, outpatient and ER services. Shannon is accredited as a Registered Health Information Administrator and a Certified Coding Specialist and a Certified Coding Specialist – Physician and an ICD-10-CM certified trainer by the American Health Information Management Association. She is also accredited as a Certified Professional Coder and a Certified Evaluation and Management Coder and is considered an approved instructor of the Professional Medical Coding Curriculum by the American Academy of Professional Coders. She is certified as a Certified Clinical Documentation Specialist and also actively serves as an advisory board member of the Association of Clinical Documentation Improvement Specialists (ACDIS). She served as the 2008-2009 Elected Director of the Virginia Health Information Management Association. Shannon holds a Bachelor of Science in Health Information Administration degree from the Medical University of South Carolina.

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  1. In the facilities that currently capture rehab procedure codes in the 93._ _ ICD-9 range, will the ICD-10-PCS codes really add much meaningful information?

  2. There has been discussion on ICd-10 for several years. I did hear about changing the overall V code for inpatient rehabilitation but I have not seen information on how or if it will affect the Impairment group code or etiologic diagnosis for the Patient Assessment Instrument.

  3. How do we code Outpatient Physical Therapy visit

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